Section 2: Exercise after a vertebral fracture Copy

Exercises after a vertebral fracture

The nature of “best exercises” still remains unclear

Improvements in back extension strength, psychological symptoms, QOL have been noted

These exercises may improve balance

Improvements in pain is not a strong finding

A trend towards improvement in vertebral morphometry has not been demonstrated strongly (Gold et al., 2004; Malmros et al., 1998; Papaioannou et al., 2003; Webber et al., 2003; Hongo et al., 2007)

High impact (jumping) is best yet studied in children and premenopausal women

NEW studies examining exercise for people with osteoporosis and vertebral fractures:

Evstigneeva et al. (2016)

Supervised group exercise – goal to increase mobility of t-spine and posture, strengthen lower extremities, abdomen, and back extensors – no flexion or axial loading
12 months, 2x/week, 40 minutes
78 women (38 control, 40 exercise) 50 years or older with osteoporosis, 1 vertebral fracture and chronic pain
2 vertebral and 2 non-vertebral fractures experienced in exercise group
Improvement in pain, quality of life, balance, and physical function (sit to stand time)

Olsen and Berland (2014)

Giangregorio et al. (2018)

Adverse Events HAVE been reported during these programs

Fractured costal cartilage during prone exercise

Fractured rib while rolling from supine to prone

Metatarsal fracture when 2lb weight fell on foot

Hip fracture after 6MO physical examination

Soft tissue pain (neck, back)

Back pain, unspecified – 2/3 returned to exercise

Pain during exercise, fall concerns (14/74)

(Gold et al., 2004; Hongo et al., 2007; Papaioannou et al., 2003)

Take-home message

No exercise is without risk, but in general, the research indicates: DO: extension (with care & appropriate positioning), flexion, rotation and side flexion should be modified and done with care in daily activities (You will learn more about this in section 8).

References

Olsen CF, Bergland A. The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial. Osteoporos Int. 2014;25(8):2017-2025. doi:10.1007/s00198-014-2724-3

Giangregorio LM, Gibbs JC, Templeton JA, et al. Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture. Osteoporos Int. August 2018. doi:10.1007/s00198-018-4652-0

Gold, D.T., Shipp, K.M., Pieper, C.F., Duncan, P.W., Martinez, S., Lyles, K.W. (2004). Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc, 52 (9), 1471-8.

Hongo, M., Itoi, E., Sinaki, M., Miyakoshi, N., Shimada, Y., Maekawa, S., et al. (2007). Effect of low- intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. Osteoporos Int, 18(10), 1389-1395.

Malmros, B., Mortensen, L., Jensen, M. B., & Charles, P. (1998). Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int, 8(3), 215-221.

Evstigneeva L, Lesnyak O, Bultink IEM, et al. Effect of twelve-month physical exercise program on patients with osteoporotic vertebral fractures: a randomized, controlled trial. Osteoporos Int. 2016;27(8):2515-2524. doi:10.1007/s00198-016-3560-4

Papaioannou, A., Adachi, J.D., Winegard, K., Ferko, N., Parkinson, W., Cook, R.J., Webber, C., McCartney, N. (2003). Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporos Int, 14(8):677-82.

Webber, C.E., Papaioannou, A., Winegard, K.J., Adachi, J.D., Parkinson, W., Ferko, N.C., Cook, R.J., McCartney, N. (2003). A 6-mo home-based exercise program may slow vertebral height loss. J Clin Densitom, 6(4): 391-400.